Feasibility of postmortem examination in the era of COVID-19 pandemic: the experience of a Northeast Italy University Hospital

Basso, Cristina; Calabrese, Fiorella; Sbaraglia, Marta; Vecchio, Claudia Del; Carretta, Giovanni; Saieva, Annamaria; Donato, Daniele; Flor, Luciano; Crisanti, Andrea; Tos, Angelo Paolo Dei

doi:10.1007/s00428-020-02861-1

Cited by 44 publications

(43 citation statements)

References 25 publications

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“…The first histopathologic reports of COVID-19-positive subjects were obtained from biopsies of alive patients, postmortem biopsies, surgical specimens, or transplanted organs [20,21,[47][48][49][50][51]. Evidence on the safety of postmortem examinations, if properly conducted, and positive/suspected SARS-CoV-2 corpse management recommendations have appeared [52][53][54][55][56][57][58], and some studies about complete autopsies of deceased SARS-CoV-2-positive patients have been published.…”

Section: Discussionmentioning

confidence: 99%

“…The features that allow us to count a decedent as a SARS-CoV-2 related death remain unclear. Many recommendations about the safety of autopsy procedures have been published [52][53][54][55][56][57][58], but to the best of our knowledge, an essential and standardized postmortem diagnostic tool for COVID-19 has not been proposed. As a consequence, the studies we reviewed show procedural differences, i.e.…”

Section: Discussionmentioning

confidence: 99%

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Autopsy findings in COVID-19-related deaths: a literature review

Maiese

Manetti

Russa

et al. 2020

Forensic Sci Med Pathol

186

172

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Although many clinical reports have been published, little is known about the pathological post-mortem findings from people who have died of the novel coronavirus disease. The need for postmortem information is urgent to improve patient management of mild and severe illness, and treatment strategies. The present systematic review was carried out according to the Preferred Reporting Items for Systematic Review (PRISMA) standards. A systematic literature search and a critical review of the collected studies were conducted. An electronic search of PubMed, Science Direct Scopus, Google Scholar, and Excerpta Medica Database (EMBASE) from database inception to June 2020 was performed. We found 28 scientific papers; the total amount of cases is 341. The major histological feature in the lung is diffuse alveolar damage with hyaline membrane formation, alongside microthrombi in small pulmonary vessels. It appears that there is a high incidence of deep vein thrombosis and pulmonary embolism among COVID-19 decedents, suggesting endothelial involvement, but more studies are needed. A uniform COVID-19 post-mortem diagnostic protocol has not yet been developed. In a time in which international collaboration is essential, standardized diagnostic criteria are fundamental requirements.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Autopsy findings in COVID-19-related deaths: a literature review

Maiese

Manetti

Russa

et al. 2020

Forensic Sci Med Pathol

186

172

View full text Add to dashboard Cite

show abstract

“…In fact, infectivity could only be determined using viral cultures [29], but this was unfortunately beyond the scope of the current study. Recently, vital virus could be transferred from lung samples from autopsies performed 6-day postmortem and cultivated in cell cultures but without reporting Ct values [30]. On the other hand, a recent correlation of Ct values with successful isolation of virus in cell cultures suggested that patients with Ct values above 33-34 were no longer contagious [31].…”

Section: Discussionmentioning

confidence: 99%

Post-mortem viral dynamics and tropism in COVID-19 patients in correlation with organ damage

et al. 2020

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The persistence of SARS-CoV-2 after death of infected individuals is unclear. The aim of this study was to investigate the presence of SARS-CoV-2 RNA in different organs in correlation with tissue damage and post-mortem viral dynamics in COVID-19 deceased. Twenty-eight patients (17 males, 11 females; age 66-96 years; mean 82.9, median 82.5 years) diagnosed with COVID-19 were studied. Swabs were taken post-mortem during autopsy (N = 19) from the throat, both lungs, intestine, gallbladder, and brain or without autopsy (N = 9) only from the throat. Selective amplification of target nucleic acid from the samples was achieved by using primers for ORF1a/b non-structural region and the structural protein envelope E-gene of the virus. The results of 125 post-mortem and 47 ante-mortem swabs were presented as cycle threshold (Ct) values and categorized as strong, moderate, and weak. Viral RNA was detected more frequently in the lungs and throat than in the intestine. Blood, bile, and the brain were negative. Consecutive throat swabs were positive up to 128 h after death without significant increase of Ct values. All lungs showed diffuse alveolar damage, thrombosis, and infarction and less frequently bronchopneumonia irrespective of Ct values. In 30% the intestine revealed focal ischemic changes. Nucleocapsid protein of SARS-CoV-2 was detected by immunohistochemistry in bronchial and intestinal epithelium, bronchial glands, and pneumocytes. In conclusion, viral RNA is still present several days after death, most frequently in the respiratory tract and associated with severe and fatal organ damage. Potential infectivity cannot be ruled out post-mortem.

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“…Postmortem examination of COVID-19 should be performed in an autopsy suite, equipped if possible with a ventilation system with six complete air changes/h (ACH) in a pressurenegative environment, with air exhausted through HEPA filters [Biosafety Level 3 (BSL3)]. A detailed autopsy/sampling protocol has recently been published by the University of Padova Pathological Section [75]. The protocol requires that a video registration be taken during the autopsy.…”

Section: Autopsy/sampling Protocolmentioning

confidence: 99%

Pulmonary pathology and COVID-19: lessons from autopsy. The experience of European Pulmonary Pathologists

et al. 2020

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Since its initial recognition in December 2019, Coronavirus disease 19 (COVID-19) has quickly spread to a pandemic infectious disease. The causative agent has been recognized as a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily affecting the respiratory tract. To date, no vaccines are available nor any specific treatment. To limit the number of infections, strict directives have been issued by governments that have been translated into equally rigorous guidelines notably for post-mortem examinations by international and national scientific societies. The recommendations for biosafety control required during specimen collection and handling have strongly limited the practice of autopsies of the COVID-19 patients to a few adequate laboratories. A full pathological examination has always been considered an important tool to better understand the pathophysiology of diseases, especially when the knowledge of an emerging disorder is limited and the impact on the healthcare system is significant. The first evidence of diffuse alveolar damage in the context of an acute respiratory distress syndrome has now been joined by the latest findings that report a more complex scenario in COVID-19, including a vascular involvement and a wide spectrum of associated pathologies. Ancillary tools such as electron microscopy and molecular biology used on autoptic tissue samples from autopsy are also significantly contributing to confirm and/or identify new aspects useful for a deeper knowledge of the pathogenetic mechanisms. This article will review and summarize the pathological findings described in COVID-19 until now, chiefly focusing on the respiratory tract, highlighting the importance of autopsy towards a better knowledge of this disease.

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Feasibility of postmortem examination in the era of COVID-19 pandemic: the experience of a Northeast Italy University Hospital

Cited by 44 publications

References 25 publications

Autopsy findings in COVID-19-related deaths: a literature review

Autopsy findings in COVID-19-related deaths: a literature review

Post-mortem viral dynamics and tropism in COVID-19 patients in correlation with organ damage

Pulmonary pathology and COVID-19: lessons from autopsy. The experience of European Pulmonary Pathologists

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